Update 2:10 p.m.: Blaming the uncertainty over health care reform in the U.S. Senate, insurance carriers will stop offering plans under the Affordable Care Act in nearly all of Nevada's rural counties, including Carson City and Douglas County.

In total, about 8,000 Nevadans will lose their insurance, with no options to buy a different subsidized plan on the federal health exchange. More than 5,000 of the people affected live in Carson City, Douglas, Storey and Lyon counties.

“My administration is working diligently to identify solutions to ensure there is, at the very least, a safety net available to rural Nevada residents who will be left without any options for coverage in the wake of these devastating and unfortunate decisions," Gov. Brian Sandoval said in a written statement. "The reduced footprint of carriers on the exchange will leave more than 8,000 Nevadans with no coverage, and that is unacceptable.”

Sandoval said he has also communicated the news to U.S. Health and Human Services Secretary Tom Price.

The news shocked the members of the Silver State Health Exchange board, who decried efforts by the U.S. Senate to repeal the Affordable Care Act.

Heather Korbulic, the exchange's director, described the situation as a "health care crisis for rural Nevada."

"It is not too late for our carriers to still work with us in Division of Insurance," Korbulic said. "We are continuing to work collectively to identify other potential solutions for the customers impacted in the event we cannot provide an on-exchange solution."

The deadline for insurance carriers to apply to provide plans on the federal health exchange passed two weeks ago with no applications to cover 14 rural Nevada counties, said Glenn Shippey, an analyst with the state insurance commission. Only Anthem currently sells plans on the exchange in those counties.

That means only residents in Washoe, Clark and Nye counties will be able to buy individual and family plans eligible for federal subsidies on the exchange next year.

Prominence, one of the state's three exchange carriers, has decided to pull out of the exchange entirely. Prominence sold plans in Washoe, Carson City and Clark.

The changes will affect about 13,000 Nevadans who currently purchase plans on the exchange.

Shippey said a new state law gives insurance carriers some flexibility with their applications, meaning some companies could potentially change their minds about selling in rural Nevada. Gov. Brian Sandoval is working with the insurance commissioner in an attempt to persuade the carriers not to leave the market.

Florence Jameson, the chairwoman of the exchange board, pleaded with the carriers to reverse their decisions to abandon rural Nevada.

"They would truly be such heroes," Jameson said. "If they could perhaps break even or take this as a loss, they would be a hero for our Nevadans."

At issue is the current Senate bill, which eliminates the mandate that individuals purchase health insurance and reduces the subsidies paid directly to insurance carriers for low income families who enroll through the exchange. Korbulic said it has become nearly impossible for companies to even write rates with the uncertainty of the cost-sharing provisions in the ACA.

"Federal instability over cost-sharing and the elimination of the individual mandate has created a very unstable market," Korbulic said. "Today we are seeing the result of this instability.

"Enforcement of the individual mandate is critical to the ongoing enrollment on the exchange," Korbulic said. "If the federal government does not enforce the federal mandate, consumers who are healthy are more unlikely to purchase health insurance... and that drives up the costs for everybody."

Insurance Commissioner Barbara Richardson said the changes proposed by Republicans in the U.S. Senate would make plans offered in rural Nevada so expensive that few could afford them.

"How much is too much cost for our consumers and is that better or worse than not having any insurance at all," she said.

In a more positive announcement, two new companies, Centene and Aetna have applied to sell plans in Washoe, Clark and Nye counties. Residents in those counties will now have four carriers to choose from.

Exchange board members were irate over attempts to repeal the Affordable Care Act.

"This is an attempt to continue to be able to say the ACA is failing, and, of course, to pressure people to then vote for what I perceive to be a diabolical bill that would provide health care to very few and provide an awful lot of money to the very rich," said board member Lavonne Lewis.

U.S. Sen. Catherine Cortez Masto, D-Nev., also decried Anthem's decision to pull out of rural Nevada.

"The uncertainty caused by Republicans and President Trump threatening to repeal the Affordable Care Act and toying with people’s healthcare is resulting in health-insurers leaving critical markets, thus hurting Nevadans’ access to life-saving care and jeopardizing the lives of many," said Sen. Catherine Cortez Masto, D-Nev. "Rural Nevadans struggle the most when it comes to access to affordable healthcare, and it is disappointing that President Trump’s reckless actions have led Anthem to reach a decision that will give Nevadans far less options for healthcare coverage that works for them."

U.S. Rep. Mark Amodei, R-Nev., who voted to pass the House bill to replace the Affordable Care Act, blamed the collapse of the exchange in rural Nevada on the "status quo."

“Sadly, this news isn’t shocking,” Amodei said in a written statement. “It represents another symptom of the sickness that is killing America’s health care system. While there are plenty of arguments on how to fix this, regardless of your political views, it’s clear the status quo isn’t working and is in need of serious repair. Once again, I’m left wondering, when is Congress going to put the issue ahead of the politics? I will continue to focus on the facts and the policy options to be applied in Nevada. As always, my goal is to ensure that any reform package increases Americans’ access to quality and affordable care, while paying respect to rural communities like ours that are being hit the hardest.”

Nevadans worried about their coverage through the exchange can call the Silver State Exchange hotline at 855-768-5465.

Original story: As the uncertainty over the Affordable Care Act, also known as Obamacare, continues to roil the market, one of three insurance carriers who offer plans to Nevadans on the federal health exchange has announced it will withdraw from the market at the end of the year.

Prominence, which provides subsidy-eligible individual and family plans, has notified the state that it will withdraw from the exchange effective Jan. 1, 2018. The move affects about 4,000 Nevadans who have coverage through Prominence.

Prominence, formerly Saint Mary's, will continue to sell small employer, large employer and Medicare plans in the state.

The move means people in Washoe County trying to buy individual or family plans will have only two carriers to choose from. In Carson City, customers will have only one carrier available.

"For people who are looking for subsidized plans, you're looking at one third of the carrier options not being available," said Matt Law, a Reno insurance broker with Health Benefits Associates. "In places like Washoe County, that could have a huge effect on consumers, but they will still have two options. I'm more concerned about people in Carson City. Starting next year they'll have only one option."

That could have a serious impact on prices, Law said. Pricing must still meet requirements by the Nevada Insurance Commission, however.

Additional information about Prominence's withdrawal from the market will be discussed at a meeting of the Silver State Health Exchange Board at 1:30 p.m. Tuesday.

Prominence's withdrawal comes as the U.S. Senate is debating a repeal of the Affordable Care Act. The U.S. Senate bill under consideration would eliminate the mandate to buy health insurance and would reduce the subsidies offered to individuals who meet certain income requirements.